Form must be filled out completely to be eligible for entry.

Name of Nominee:                     Name of Nominator:

Name for Awards/Media, etc:   Nominator Email:        

                                                                                                       Nominator Telephone:

Current Address:

Home Telephone:

Work Telephone:

Email Address:

Fax:

Lafayette College, Class of:

Years of participation (e.g.1976-80):

Sports participated in while at Lafayette (years):

Marital Status/Name of Spouse:

Date of Birth:

Children's Names and Ages:

Contact for Nominee (if different from Nominee):

Contact Home Telephone:

Please be specific with honors and dates (i.e. All-American, Associated Press 2nd team 1969, etc.). Also include any additional material, which would support the nomination (i.e. newspaper clips, game programs, school records, individual and/or teams, testimonials from former coaches, players, a photo of yourself as a student-athlete, etc.). Attach additional pages if needed. NOTE: Please specify any material you wish to be returned.

Primary Sport:

Position or Events:

Coach's Name:

Honors Received:

Post-Graduate Athletic Experience:

Present Status (employed, retired, etc.):

Other Relevant Information:

Please list any other former Lafayette student-athletes, coaches or support personnel you feel is a deserved candidate for the Lafayette Maroon Club Hall of Fame:

Coach's Comments:

Teammates' Comments:

Please forward any supporting nomination materials to: Office of Athletic Communications, Lafayette College, 107 Kirby Sports Center, Easton, PA 18042. Thank you.